| NPI | 1720471253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5796) |
| 101YM0800X Counselor, Mental Health (Licence: NE 12234) | |
| 1041C0700X Social Worker, Clinical (Licence: NE 2113) | |
| 1041C0700X Social Worker, Clinical (Licence: NE 7489) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2022-02-26 |